November 29, 2004

Prescription Pressures From Drug Companies Not What the Nurses Ordered

THOUSANDS of Scottish nurses are being bombarded with approaches from pharmaceutical companies since being allowed to prescribe medicines two years ago.

While drug companies traditionally focused their efforts of doctors, greater freedoms for nurses to write prescriptions has meant that they are increasingly the target of a drug industry which is worth millions of pounds.

Nurses have been able to write out prescriptions since 2002, subject to them receiving extra training.

The move is regarded by health experts as an important extension of patient care because it means that it is easier for people needing routine medicines to get the care they need, while it allows doctors to focus on the more acute cases.

But the new freedom has meant that nurses have had to learn how to keep their distance from pharmaceuticals companies. Doctors and consultants have already been the focus of controversy because of the 'freebie culture' which surrounds the links between the medical profession and drugs' companies.

Critics are concerned that prescribing decisions may be affected by a 'free lunch culture' which sees doctors whisked off to conferences and briefing seminars that are often held in plush hotels or overseas.

One senior nurse said: "I could end up with having an invite to see a rep more than [once] every day. I try to limit myself to one or two a week, but then I find I still am knocking another four back."

Another nurse claimed she frequently felt under pressure from pharmaceutical companies. She said: "Sometimes you will have a rep calling up and offering to switch all your patients with a particular condition to their drug and they will give you a special deal, say 20p off each preparation for each patient. That can save you a lot of money very quickly, so you do feel under a lot of pressure.

"Other times you will have a company sending round two or three reps a week to see you. Also there are reps who try and build a relationship with you because they see you so often. It's like you end up feeling you are hurting a friend when you decide not to opt for their product."

Dr Des Spence, a Glasgow GP and the head of the 'No Free Lunch Organisation', which campaigns for greater openness in the contacts between the pharmaceutical industry and the medical profession, said: "We do not object to the companies telling medical professionals about their products, but we believe this cosy culture can work against the interests of the patient.

"We believe there should be a public register of interests, where doctors and nurses and pharmacists will have to list all their contacts with the industry and all the hospitality they have received. That would generate a peer pressure which would mean the whole profession would become much more careful about their contacts and how they were making their prescribing decisions."

Gilly Henry, a Glasgow-based nurse, said: "Nurses have to be very disciplined and focused to make sure that we are not being influenced. Personally, I think that the contacts between the industry and the profession can be very positive, but you have to make sure that you never allow contacts to influence your decisions. As long as you abide by guidelines to put the patient first, you should be fine. The pitfalls are there for the less experienced nurses."

A spokesman for the Association of the British Pharmaceutical Industry Scotland rejected suggestions that the industry was trying to buy influence among nurses.

He said: "The patient is protected by a number of safeguards. First of all the industry is very regulated in what kind of hospitality can be offered.

"The values of gifts are limited to GBP 6 and hospitality may not be worth more than the medical professional could normally afford. The professions are also protected by their own rules and guidelines, which insist that they must always act only in the interests of the patient."

Studies have shown that it is well worth companies while to woo health professionals, including medical students.

In one US study, medical students in Chicago were asked to recall interactions with pharmaceutical representatives. They reported being sceptical of representatives who ignored them because they were students, but they rated as helpful and informative those who conversed with them or gave them gifts.